Provider Demographics
NPI:1740601079
Name:TABB HEALTHCARE, LLC
Entity Type:Organization
Organization Name:TABB HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:TABB
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS
Authorized Official - Phone:757-513-9195
Mailing Address - Street 1:2800 ERIC CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-2744
Mailing Address - Country:US
Mailing Address - Phone:757-513-9195
Mailing Address - Fax:
Practice Address - Street 1:3029 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-2828
Practice Address - Country:US
Practice Address - Phone:757-513-9195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2057320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities